The anatomy
of the inguino-femoral region viewed via a telescope placed in
intra-abdominal position differs radically from the anatomy observed via
an open or anterior approach. The laparoscopic surgeon needs to become
familiar with the anatomical structure of this region. As all anatomical
landmarks are covered with peritoneum, in the TAPP technique the
peritoneum has to be first incised and a lower flap developed in order to
expose the region adequately. In the TEP repair, the anatomical landmarks
need to be meticulously exposed with blunt dissection.

Our guidelines for the performance of a safe and
secure laparoscopic inguinal hernia repair, mandate the following
structures should be clearly and unequivocally identified:

Cooper's Ligament

The Epigastric Vessels

The Spermatic Cord or the Round Ligament

The Femoral Canal and the Iliac Vessels

In addition, the laparoscopic anatomical
distinction between direct, indirect inguinal and femoral hernias should
be well understood. Before a surgeon attempts to perform a laparoscopic
inguinal or femoral hernia repair, he should memorize and be very
familiar with the following diagrams.